Sedentary Patients Research Articles

Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial.

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS.

Enhancement of PVDF Sensing Characteristics by Retooling the Near-Field Direct-Write Electrospinning System.

This research aimed to develop a direct-write near-field electrospinning system (DW-NFES) with three-axis positioning of controllable speed, torque and position to produce sizable and high-quality piezoelectric fibers for sensing purposes. Sensor devices with high electrical response signals were developed and tested. To achieve DW-NFES purpose, a servo motor controller was designed to develop a high response rate, accurate positioning, and stable mobile device through the calculation of bandwidth and system time delay. With this retooled system of DW-NFES, controllable and uniform size fibers in terms of diameters, stretching force, and interspaces can be obtained. Sensor devices can be made selectively without a complicated lithography process. The characteristics of this DW-NFES platform were featured by high response rate, accurate positioning, and stable movement to make fibers with high piezoelectric property. In this study, polyvinylidene fluoride (PVDF) was used to explore and enhance their sensing quality through the platform. The parametric study of the process factors on piezoelectric sensing signals mainly included the concentration of electrospinning PVDF solution, high voltage electric field, and collection speed. Finally, the surface morphology and piezoelectric properties of the as-electrospun PVDF fibers were examined by scanning electron microscopy (SEM) and characterized by electrical response measurement techniques. The results showed that the fiber spinning speed of the DW-NFES system could be increased to ~125 from ~20 mm/s and the accuracy precision was improved to ~1 from ~50 μm, compared to conventional step motor system. The fiber diameter reached ~10 μm, and the electrospinning pitch reached to as small as ~10 μm. The piezoelectric output voltage of the electrospun fibers was increased ~28.6% from ~97.2 to ~125 mV; the current was increased ~27.6% from ~163 to ~208 nA, suggesting that the piezoelectric signals can be enhanced significantly by using this retooled system. Finally, an external control module (Arduino-MAGE) was introduced to control the PVDF piezoelectric fiber sensors integrated as a sensing array. The behavior of long-term sedentary patients can be successfully detected by this module system to prevent the patients from the bedsores.

Low Vitamin C Status in Patients with Cancer Is Associated with Patient and Tumor Characteristics.

Vitamin C (ascorbate) acts as an antioxidant and enzyme cofactor, and plays a vital role in human health. Vitamin C status can be affected by illness, with low levels being associated with disease due to accelerated turnover. However, robust data on the ascorbate status of patients with cancer are sparse. This study aimed to accurately measure ascorbate concentrations in plasma from patients with cancer, and determine associations with patient or tumor characteristics. We recruited 150 fasting patients with cancer (of 199 total recruited) from two cohorts, either prior to cancer surgery or during cancer chemo- or immunotherapy. A significant number of patients with cancer had inadequate plasma ascorbate concentrations. Low plasma status was more prevalent in patients undergoing cancer therapy. Ascorbate status was higher in women than in men, and exercising patients had higher levels than sedentary patients. Our study may prompt increased vigilance of ascorbate status in cancer patients.

Physical activity in patients with Parkinson’s disease: A holistic approach based on the ICF model

ObjectivesThe International Classification of Functioning, Disability and Health (ICF) is a framework providing information on disability and health. Physical activity’s behavior is complex and affected by various factors. We aimed to examine the ICF domains in Parkinson’s disease (PD) patients; to compare them in sedentary and non-sedentary PD patients and their association with activity level. Patients and MethodsSixty PD patients (25 sedentary PD group, 35 non-sedentary PD group) were included in this retrospective study. Functional disability was evaluated using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. The physical activity level was measured by the SenseWear Arm Band activity monitor. Patients’ cognitive function, severity of depression and anxiety, the functional impact of fatigue, balance performance (NeuroCom Balance Master System), functional mobility (Timed Up and Go Test, TUG), walking capacity (Six-Minute Walk Test, 6MWT), fear of falling, health-related quality of life are also analyzed. ResultsSedentary PD patients had worse scores in NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in activities domains of the ICF model as a guide than non-sedentary group (p < 0.05). No statistically significant differences were found in the body structures and function, participation, personal and environmental domains of the ICF model between sedentary and non-sedentary PD groups (p > 0.05). There was no correlation between steps taken per day and NeuroCom Balance Master System parameters, TUG score, and 6MWT distance in both groups (p > 0.05). ConclusionPatients with sedentary lifestyle had worse scores in postural control/balance, sit-to-stand and walking performance. However, deteriorated dynamic balance may not lead to sedentary lifestyle. Physiotherapy programs should be including the behavior change interventions and motivational strategies to promote activity level in PD.

Personalized Approach for the Management of Exercise-Related Glycemic Imbalances in Type 1 Diabetes: Comparison with Reference Method.

One of the most frequently adopted strategies to counterbalance the risk of exercise-induced hypoglycemia in patients with type 1 diabetes is carbohydrates supplement. Nevertheless, the estimation of its amount is still challenging. We investigated the efficacy of the personalized Exercise Carbohydrate Requirement Estimation System (ECRES) method compared to a tabular approach to estimate the glucose supplement needed for the prevention of exercise-related glycemic imbalances. Twenty-six patients performed two one-hour constant intensity exercises one week apart; the amount of extra carbohydrates was estimated, in random order, by the personalized ECRES method or through the tabular approach; glycemia was determined every 30 minutes. Continuous glucose monitoring (CGM) metrics were calculated over the 48 hours preceding, and the afternoon and night following the trials. Applying the personalized ECRES method, a significantly lower amount of carbohydrates was administered to the active patients compared to the tabular approach, median (interquartile range): 9.0 (0.5-21.0) g vs 23.0 (21.0-25.0) g; P < .01; the two methods were similar for the sedentary patients, 18 (13.5-36.0) g vs 23.0 (21.0-27.0) g; P = NS. After overlapping CGM metrics before the exercises, both methods avoided hypoglycemia and resulted in similar glucose levels throughout them. The ECRES method led to CGM metrics within the guidelines for either the afternoon and the night just following the trials, whereas the tabular approach resulted in a significantly greater time below range in the afternoon (11.8% ± 18.2%; P < .05) and time above range during the night (39.3% ± 29.8%; P < .05). The results support the validity of the personalized ECRES method: although the estimated amounts of carbohydrates were lower, patients' glycemia was maintained within safe clinical limits.

Physical Activity Is Critical To Preserve Cognitive Function In Nephrology Patients

Chronic kidney disease (CKD) associates with earlier onset of cognitive impairment. Physical activity (PA) improves neuronal plasticity and cognitive function among older adults. However, limited data exist exploring the effect of PA on cognitive function in CKD patients. PURPOSE: To investigate the effect of regular physical activity on cognitive function in CKD patients. METHODS: We analyzed 68 patients with CKD admitted to a Midwestern hospital between January 2017 and July 2018. All subjects provided a health history, had a comprehensive metabolic panel with estimated glomerular filtration rate (eGFR), and reported whether they engaged in regular physical activity (PA). Cognitive impairments, including dementia, Alzheimer's, and Parkinson's disease were documented. Independent-samples t-tests and chi-squared tests compared patient profiles between sedentary and active patients. Logistic regression analyses tested the effect of PA on cognitive impairments holding constant other significant predictors. RESULTS: Patients were 64.7 ± 17.4 years old, had an eGFR of 24.7 ± 13.8 mL/min, 66.2% were sedentary, and 25.0% had a cognitive impairment. Older subjects were more likely to have a diagnosis of cognitive impairment (p=0.051) and the prevalence was higher in sedentary patients (33.3%) than in those who were physically active (8.7%; p=0.026). Holding constant the age of the patient and the stage of CKD, engagement in PA shared a trending association with mental impairment (p=0.056), predicting a 79.8% reduction in the likelihood of diagnosis (Pseudo R2 = 0.187; 95% CI of OR: 0.039 to 1.040). Similarly, controlling for eGFR rather than CKD stage, the significance of PA as a predictor remained stable (p=0.057; 95% CI of OR: 0.039 to 1.052). CONCLUSIONS: Patients with CKD experience a higher risk of cognitive impairment than age-matched controls. In our sample, engagement in regular physical activity demonstrated a protective effect, and sedentary behavior influenced diagnosis more than age.

Muscle Cross-sectional Area Improves With Home-based Training During Metastatic Castration-resistant Prostate Cancer

PURPOSE: Exercise training improves regional body composition in localized prostate cancer, but it is unknown if training has similar effects in advanced disease. Goals of this analysis were to determine changes in leg muscle cross-sectional area (CSA) and quality (MQ) values following home-based exercise training during metastatic castration-resistant prostate cancer (mCRPC) and to compare CSA values to healthy controls (CON). METHODS: Sedentary mCRPC patients undergoing androgen deprivation therapy (ADT) including next generation androgen receptor signaling inhibitors (n = 17, age = 71y ± 8, BMI = 32.0 kg/m2 ± 6.5) underwent CSA and MQ analyses using B-mode ultrasound for the vastus lateralis (VL) muscle before and after a 12-week home-based exercise protocol. Age- and BMI-matched CON (n = 17, age = 69y ± 2, BMI = 32.8kg/m2 ± 6.5) completed baseline scans only. RESULTS: At baseline, VL CSA was lower in mCRPC (9.12cm2+ 3.15) relative to CON (36.55cm2 ± 7.04, p<0.001, d=4.95). For mCRPC patients, the 12-week intervention did not change VL MQ, but increased CSA by 15.2% following the intervention (pre: 8.28cm2 ± 2.85, post: 9.54 ± 3.56, p<0.001, d= 0.39) with no change in MQ. CONCLUSIONS: Patients undergoing ADT for advanced prostate cancer exhibit lower muscle size compared to CON; however preliminary results suggest that home-based exercise training induces a moderate degree of regional muscle hypertrophy. The finding of regional hypertrophy is consistent with work conducted in patients with localized disease on ADT and may be an important outcome to monitor if increases in muscle CSA translate into improvements in physical function and quality of life. Supported by Physical Activity and Cancer Survivorship Pilot Funding.

High Intensity Exercise Training In Patients With Hypertrophic Cardiomyopathy

Patients with hypertrophic cardiomyopathy (HCM) are excluded from high intensity activities due to perceived fear of sudden cardiac death though data from athletes with HCM suggest competitive sport may be safe for some. Low cardiorespiratory fitness in sedentary HCM patients may confer a greater lifetime cardiovascular event risk than exercise per se. While moderate intensity exercise training in patients with HCM modestly increases fitness, high intensity exercise may be superior. PURPOSE: To compare the efficacy of five months of moderate intensity exercise and high intensity exercise training to improve cardiorespiratory fitness (V̇O2max) in patients with HCM. METHODS: Eight patients with HCM (50 ± 7 years, 3 female) were assessed for maximal oxygen uptake (V̇O2max, Douglas Bag method), cardiac output (Q̇c, acetylene rebreathing), and peripheral oxygen extraction (av-O2 diff, Fick equation) before randomization and after 5 months of moderate or high intensity exercise training. Patients completed 3-4 sessions of moderate intensity exercise each week, while the high intensity group also incorporated a weekly interval training session. RESULTS: Five months of moderate intensity exercise increased absolute V̇O2max by 3% and relative V̇O2max by 4%, while high intensity exercise consistently increased absolute V̇O2max by 6% and relative V̇O2max by 5% (Figure). Maximal Q̇c did not change after moderate intensity exercise (+0.0L [95% CI -2.0 to 1.7]) but increased in all three patients after high intensity exercise (+1.2L [95% CI -1.4 to 3.9]), while maximal av-O2 diff remained stable in both groups (moderate intensity: +0.8mL/100mL [95% CI -1.0 to 2.6]; high intensity: -0.5mL/100mL [95% CI -3.6 to 2.7]). CONCLUSION: Preliminary findings show similar increases in cardiorespiratory fitness following five months of moderate and high intensity exercise training in patients with HCM, although improvements were more consistent after high intensity exercise.

Novel Biomarkers Of Treatment-Induced Muscle Damage, Exercise And Fatigue: An RCT In Breast Cancer Patients

Radiation and hormone therapy may damage skeletal muscle and lead to cancer-related fatigue (CRF). Developmental myosin light chain 5 (MYL5) and myosin heavy chain 8 (MYH8) are required for normal muscle regeneration. Up-regulated serum levels of MYL5 and MYH8 resulting from radiation and hormone therapy may increase muscle degradation and lead to CRF, especially physical CRF—one of the multidimensional subcomponents of overall CRF. PURPOSE: To investigate the effect of a 6-week aerobic and anaerobic exercise intervention, called Exercise for Cancer Patients (EXCAP), on (1) CRF (overall and physical), (2) serum protein levels of MYL5 and MYH8, and (3) the association of CRF (overall and physical) with these novel biomarkers. METHODS: Ninety sedentary breast cancer patients (55.5±9.6 years, 79% white, 52% receiving radiation therapy, 48% receiving hormone therapy) were consented and participated in this phase II RCT. Patients were randomized into two arms: (1) standard cancer treatment (Control) or (2) standard cancer treatment plus EXCAP. Serum levels of MYL5 and MYH8 by ELISA assays and CRF (total and physical) by patient-report via the Multidimensional Fatigue Symptom Inventory were assessed pre- and post-intervention. RESULTS: T-tests showed significant reductions in overall CRF and physical CRF among exercisers (overall CRF: -4.9±2.6, p=0.07, physical CRF: -1.0±0.5, p=0.05) but not in controls, with significant group differences (overall CRF: -7.9±3.4, p=0.02; physical CRF: -1.9±0.7, p<0.01). T-tests also revealed statistical trends for down-regulation of MYL5 (-0.5±0.3, p=0.17) and MYH8 (-0.4±0.3, p=0.17) serum protein levels from pre- to post-intervention in exercisers, but not in controls. Spearman correlations also reveal statistical trends, in exercisers, where decreases in MYL5 and MYH8 serum protein levels are directly associated with decreases in total CRF (MYL5 r=0.23, p=0.17; MYH8 r=0.30, p=0.07) and physical CRF (MYL5 r=0.29, p=0.08; MYH8 r=0.39, p=0.02). CONCLUSIONS: EXCAP improves overall and physical CRF. EXCAP may also protect against cancer treatment-induced skeletal muscle damage via its effects on MYL5 and MYH8. Changes in these novel biomarkers may mediate changes in overall and physical CRF. Further phase III RCTs are needed to confirm these findings.

A Mind-Body Physical Activity Program for Chronic Pain With or Without a Digital Monitoring Device: Proof-of-Concept Feasibility Randomized Controlled Trial.

BackgroundChronic pain is associated with poor physical and emotional functioning. Nonpharmacological interventions can help, but improvements are small and not sustained. Previous clinical trials do not follow recommendations to comprehensively target objectively measured and performance-based physical function in addition to self-reported physical function.ObjectiveThis study aimed to establish feasibility benchmarks and explore improvements in physical (self-reported, performance based, and objectively measured) and emotional function, pain outcomes, and coping through a pilot randomized controlled trial of a mind-body physical activity program (GetActive) with and without a digital monitoring device (GetActive-Fitbit), which were iteratively refined through mixed methods.MethodsPatients with chronic pain were randomized to the GetActive (n=41) or GetActive-Fitbit (n=41) programs, which combine relaxation, cognitive behavioral, and physical restoration skills and were delivered in person. They completed in-person assessments before and after the intervention. Performance-based function was assessed with the 6-min walk test, and step count was measured with an ActiGraph.ResultsFeasibility benchmarks (eg, recruitment, acceptability, credibility, therapist adherence, adherence to practice at home, ActiGraph wear, and client satisfaction) were good to excellent and similar in both programs. Within each program, we observed improvement in the 6-min walk test (mean increase=+41 m, SD 41.15; P<.001; effect size of 0.99 SD units for the GetActive group and mean increase=+50 m, SD 58.63; P<.001; effect size of 0.85 SD units for the GetActive-Fitbit group) and self-reported physical function (P=.001; effect size of 0.62 SD units for the GetActive group and P=.02; effect size of 0.38 SD units for the GetActive-Fitbit group). The mean step count increased only among sedentary patients (mean increase=+874 steps for the GetActive group and +867 steps for the GetActive-Fitbit group). Emotional function, pain intensity, pain coping, and mindfulness also improved in both groups. Participants rated themselves as much improved at the end of the program, and those in the GetActive-Fitbit group noted that Fitbit greatly helped with increasing their activity.ConclusionsThese preliminary findings support a fully powered efficacy trial of the two programs against an education control group. We present a model for successfully using the Initiative on the Methods, Measurement, and Pain Assessment in Clinical Trials criteria for a comprehensive assessment of physical function and following evidence-based models to maximize feasibility before formal efficacy testing.Trial RegistrationClinicalTrial.gov NCT03412916; https://clinicaltrials.gov/ct2/show/NCT03412916

Abstract D033: High-intensity interval training is feasible in Hispanic patients with breast cancer undergoing anthracycline chemotherapy

Abstract Background and Purpose Chemotherapy may initiate and worsen comorbid conditions such as obesity, diabetes, and cardiovascular disease in women undergoing treatment for breast cancer. Hispanic women are more likely to be obese and physically inactive than matched non-Hispanic counterparts, increasing the risk for developing comorbid conditions during chemotherapy. High intensity interval training (HIIT) is a safe, time-efficient exercise strategy that has been deemed more effective than moderate continuous aerobic exercise at improving cardiovascular health in patients with heart failure and stroke. The study purpose was to determine whether a HIIT intervention is a feasible exercise strategy for Hispanic patients with breast cancer undergoing anthracycline-based chemotherapy. Experimental Design Sedentary, overweight or obese (BMI³25.0 kg/m2) Hispanic patients with breast cancer (Stage I-III;) were randomized to exercise (n=11) or control (n=11). Participants performed a maximal cycling fitness test to measure peak power output (PPO) during maximal oxygen uptake (VO2max). The exercise group participated in an 8-week HIIT intervention occurring 3 times weekly. Adherence measures used to define feasibility were calculated for each participant by computing (1) the average weekly minutes of HIIT over 8 weeks and (2) the number of sessions attended and multiplied by 100 (percentage of sessions). The HIIT intervention was considered feasible if more than 50% of participants completed both an average of 70% of weekly minutes (63/90 minutes) and attended 70% exercise sessions (17/24 sessions). Descriptive statistics were performed for exercise adherence in the exercise group. Paired sample t-test was used to compare VO2max from baseline to post-intervention in the exercise group. Summary of Results Eleven Hispanic women with an average age of 48.9±6.2 years and BMI of 34.8±7.3 kg/m2 were included. The average weekly minutes of exercise completed was 80.2±6.9 out of 90 minutes. The exercise group attended an average of 20.1±3.8 (83.8%) out of 24 sessions. Nine of 11 (82%) participants in the exercise group met both feasibility criteria. No adverse events occurred. VO2max was not significantly changed in the exercise group (15.6±5.1 to 15.8±4.3, p=0.92) while significantly reduced in the control group (18.1±3.3 to 16.0±3.1, p=0.001) following 8 weeks. Conclusions HIIT is a feasible exercise intervention in Hispanic patients with breast cancer receiving anthracycline-based chemotherapy, as demonstrated by the high adherence to the intervention. HIIT should be considered a safe, feasible exercise strategy to utilize among minority patients with cancer. Citation Format: Kyuwan Lee, Karina Ortiz, Jessica Goytizolo, Theresa Serrano, Christina M Dieli-Conwright. High-intensity interval training is feasible in Hispanic patients with breast cancer undergoing anthracycline chemotherapy [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D033.

Exercise Attenuates the Transition from Fatty Liver to Steatohepatitis and Reduces Tumor Formation in Mice.

Non-alcoholic fatty liver disease (NAFLD) leads to steatohepatitis (NASH), fibrosis, and hepatocellular carcinoma. For sedentary patients, lifestyle interventions combining exercise and dietary changes are a cornerstone of treatment. However, the benefit of exercise alone when dietary changes have failed is uncertain. We query whether exercise alone arrests the progression of NASH and tumorigenesis in a choline-deficient, high-fat diet (CD-HFD) murine model. Male C57Bl/6N mice received a control diet or CD-HFD for 12 weeks. CD-HFD mice were randomized further for 8 weeks of sedentariness (SED) or treadmill exercise (EXE). CD-HFD for 12 weeks produced NAFL. After 20 weeks, SED mice developed NASH and hepatic adenomas. Exercise attenuated the progression to NASH. EXE livers showed lower triglycerides and tumor necrosis factor-α expression, less fibrosis, less ballooning, and a lower NAFLD activity score than did SED livers. Plasma transaminases and triglycerides were lower. Exercise activated AMP-activated protein kinase (AMPK) with inhibition of mTORC1 and decreased S6 phosphorylation, reducing hepatocellular adenoma. Exercise activated autophagy with increased LC3-II/LC3-I and mitochondrial recruitment of phosphorylated PTEN-induced kinase. Therefore, exercise attenuates the transition from NAFL to NASH, improves biochemical and histological parameters of NAFLD, and impedes the progression of fibrosis and tumorigenesis associated with enhanced activation of AMPK signaling and favors liver autophagy. Our work supports the benefits of exercise independently of dietary changes.

Inflammatory and clinical risk factors for chemotherapy-induced peripheral neuropathy (CIPN): A nationwide longitudinal study in 143 cancer patients during chemotherapy.

12099 Background: CIPN is a common dose-limiting side effect of taxane and platinum chemotherapy. It is difficult for clinicians to predict who will experience CIPN before initiating chemotherapy, partly because the etiology of CIPN is poorly understood. Specifically, although inflammation putatively plays a role in CIPN, there is limited evidence of the role of inflammation in CIPN in humans. Here, we identified the strongest predictors of CIPN using variables measured before taxane or platinum chemotherapy, including serum inflammation. Methods: 143 sedentary patients with cancer (81% breast, 7% colon, 5% lung; 7% other; mean age 56 years) receiving taxane or platinum chemotherapy rated the severity of (a) numbness and tingling, and (b) hot/coldness in hands/feet on 0-10 point scales before and after their first 6 weeks of chemotherapy. Linear regression models were fit to predict CIPN symptom severity at 6 weeks using variables related to inflammation (serum IL-1β, IL-6, IL-8, IL-10, IFN-γ, sTNFR1; 69 patients who gave blood), clinical factors (cancer stage, baseline neuropathy, fatigue, anxiety, depression, using diabetes medications), behavior (daily pedometer steps), and demographics (age, race) measured before chemotherapy. The final model was identified by the smallest AIC goodness of fit. Results: The strongest pre-chemotherapy predictors of numbness and tingling after 6 weeks of taxane and/or platinum chemotherapy were worse patient-reported fatigue/anxiety/depression (explaining 25% of variance), platinum chemotherapy (7%), and older age (5%). The strongest predictors of hot/coldness in hands/feet included worse baseline neuropathy (13%), platinum chemotherapy (8%), and fatigue/anxiety/depression (6%). In the 69 patients with serum data, a more pro-inflammatory state was a risk factor for CIPN as higher levels of pro-inflammatory IL-1β (7%) predicted numbness/tingling, and lower levels of anti-inflammatory IL-10 (7%) predicted hot/coldness in hands/feet. Conclusions: The strongest pre-chemotherapy predictors of CIPN included worse fatigue/anxiety/depression and platinum chemotherapy in this sedentary population of cancer patients (mostly breast). A pro-inflammatory state before chemotherapy may also increase risk for CIPN, suggesting that inflammation may underlie the etiology of CIPN in humans. Clinicians should consider assessing these factors to inform the patient’s risk for CIPN. Funding: NCI UG1CA189961, NCI K07 K07CA221931, T32CA102618. Clinical trial information: NCT00924651 .

Physical activity promotion for multimorbid patients in primary care settings: a protocol for a systematic review evaluating health benefits and harms

BackgroundTo date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally, and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable diseases. The objective of this study will be to evaluate the health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings.MethodsThis is the study protocol for a systematic review. We will search PubMed, MEDLINE (Ovid), Web of Science, CINHAL, and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomized controlled trials, quasi-experimental, and non-randomized trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g., two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo, or medications. Two reviewers will independently screen all citations, abstracts data, and full-text articles. The primary outcomes will be health-related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease-specific outcomes (e.g., depression score), biomarkers as well as control of metabolic risk factors (e.g., blood pressure, HBA1c, body weight) and any adverse event. The methodological quality of the studies will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE).DiscussionThis review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers, and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed.Systematic review registrationOpen Science Framework (registration identifier: osf.io/ka8yu)

Diet high in protein-rich foods with structured sport activity may be useless to lose fat mass and maintain fat-free mass.

The aim of this study was to demonstrate that a normal protein diet along with minimal sports activity can be enough to lose fat mass and maintain muscle mass. All participants were prescribed a hypocaloric nutritionally balanced Mediterranean-style diet tailored to the individual for 8 weeks. Body composition and energy expenditure were measured. Sedentary patients (G1) were only recommended to perform minimal aerobic training, while sport subjects (G2) were prescribed structured physical activity and higher calorie and protein contents in the diet. There were no significant differences between the two groups for any of the measured parameters. The models of lifestyle changes that are currently circulating were for the most part ineffective. It does not appear to be necessary to increase the protein content of the diet above that recommended by guidelines in order to lose weight. Even prescribing specific physical activity is not necessary to maintain muscle mass.

Association between physical activity and sedentary behaviour on carotid atherosclerotic plaques: an epidemiological and histological study in 90 asymptomatic patients

ObjectiveCarotid atherosclerotic plaques are a source of emboli for stroke. ‘Unstable’ carotid atherosclerotic plaques may have intraplaque haemorrhages, neovessels, prevalent macrophages, excessive calcium deposits, a large lipid core and a...

The frequency of neuropathic pain in Turkish patients with low back pain: a cross-sectional study.

The aim of this study was to evaluate the frequency of neuropathic pain (NP) in patients with low back pain (LBP) and the relationship of NP with demographic characteristics and pain duration. Four hundred and forty patients were evaluated with respect to NP. Demographic data were collected and Douleur Neuropathique 4 Questions (DN4) questionnaire was used to identify NP. Any difference in demographic characteristics or duration of pain was investigated between the patients with and without NP. Sociodemographic factors which are independently associated with NP were analyzed. According to DN4, 43.9% of the patients had NP. Mean age of the patients was 44.8years (± 13.7). 343 (77.9%) of the patients had chronic LBP (more than 3months). The patients with NP were older (p < 0.001), had higher BMI (p = 0.005) and longer LBP duration (p < 0.001) and had lower educational level (p 0.018). NP was significantly more common in unemployed patients and less common in high-activity employees (p 0.001). Logistic regression analyses identified that high-active workers' risk of having NP was 1.76 times lesser than other groups (office workers, housewives and retired patients). Nearly half of the patients with LBP were accompanied by NP. It was remarkably more common in sedentary patients and patients with low socioeconomic status. High physical activity at work was found to decrease the risk of having NP. Clinicians should emphasize on exercise training as a therapeutic intervention while LBP is being treated.

Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor

Background: Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear. Purpose/Hypothesis: The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients. Study Design: Cohort study; Level of evidence, 3. Methods: A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared. Results: A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears. Conclusion: Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.

Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial.

A decline in physical function is highly prevalent and a poor prognostic factor in cirrhosis. We assessed the benefits of a home-based physical activity program (HB-PAP) in patients with cirrhosis with a randomized pilot trial. All participants received a personal activity tracker to monitor daily activities and were given 12g/day of an essential amino acid supplement. The HB-PAP intervention consisted of biweekly counseling sessions to increase physical activity for 12weeks. Six-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET) assessed changes in aerobic fitness. Different anthropometric measuring tools were used for skeletal muscle and adiposity assessment. Seventeen patients (60% male; 29% nonalcoholic steatohepatitis/cryptogenic, 29% hepatitis C, 24% alcohol, 18% other) were randomized, 9 to HB-PAP group. There were no significant differences in MELD-sodium between HB-PAP and controls at baseline or after the 12-week intervention. By the end of study, there was a significant between-group difference in daily step count favoring the active group (2627 [992-4262], p = 0.001), with less sedentary patients in the active group (33-17% vs. 25-43%, p = 0.003). The 6MWT improved in the HB-PAP group (423 ± 26m vs. 482 ± 35m), while the controls had a nonsignificant drop (418 ± 26m vs. 327 ± 74m) with a significant between-group difference. CPET did not change. Other than an improvement in psoas muscle index, there were no differences in anthropometry, or in quality of life. HB-PAP maintained physical performance and improved aerobic fitness according to 6MWT but not CPET, supporting the use of personal activity trackers to monitor/guide home-based prehabilitation programs in cirrhosis.

P363 Cardiac magnetic resonance characteristics of patients in the grey zone of hypertrophy

Abstract Funding Acknowledgements National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277); Project no. NVKP_16-1-2016-0017. Supported by the ÚNKP-18-3-IV Background Differentiation between athlete’s heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy. Purpose We aimed to analyse cardiac magnetic resonance (CMR) characteristics of healthy athletes, sedentary HCM and athletic HCM patients in the grey zone of hypertrophy. Methods Male HCM patients with slightly elevated maximal end-diastolic wall thickness (EDWT 13-18 mm) and highly trained healthy athletes (n = 34, 20.4 ± 2.3 training hrs/week) were consecutively enrolled. HCM patient group was divided to sedentary (n = 35, &amp;lt;7 training hrs/week) and athletic HCM group (n = 13; &amp;gt;7 h/week, 13.2 ± 5.0 h training hrs/week).We determined conventional CMR parameters (left ventricular (LV) ejection fraction (EF),BSA-corrected end-diastolic (EDVi) and end-systolic volume (ESVi), mass (Mi)), derived parameters such as EDWT/LVEDVi, LVM/LVEDV and CMR based strain parameters such as global longitudinal (GLS), radial (GRS) and circumferential strain (GCS), standard deviation of peak LS, RS and CS (SD LS peak, SD RS peak, SD CS peak), standard deviation of time to peak LS, RS and CS (TTP LS, TTP RS, TTP CS) using feature tracking. Presence of late gadolinium enhancement (LGE) was determined on delayed contrast enhanced images. Inter-observer analysis for strain values was performed in a subgroup of 20 patients conducted by two blinded observer. Results Healthy athletes showed lower LVEF, GCS and GRS than sedentary and athletic HCM patients, respectively (57.9 ± 5.2 vs 65.3 ± 7.4, 62.7 ± 5.1; -19.7 ± 7.0 vs -24.4 ± 4.6, -22.8 ± 4.8; 61.7 ± 11.2 vs 75.4 ± 21.4, 69.3 ± 19.8). Both healthy athletes and athletes with HCM showed higher LVEDVi, LVESVi, LVSVi and LVMi than sedentary HCM patients. Although sedentary athletes showed higher SD peak strain values and more pronounced intraventricular dyssynchrony than healthy athletes (TTP LS 15.4 ± 4.9 vs 11.7 ± 4.3), none of the global strain values, SD of peak strain values or TTP strain values showed any difference between athletic HCM and healthy athletes. EDWT/LVEDVi ratio was significantly lower in healthy athletes than in sedentary and athletic HCM, respectively (0.11 ± 0.02 vs 0.19±.0.04; 0.18 ± 0.04). Inter-observer analysis showed good agreement in GLS (κ=0.77), GRS (κ=0.69) and TTP LS (κ=0.74), moderate agreement in GCS (κ=0.54), and only fair or poor agreement in SD peak strain, TTP CS and TTP RS values. None of the healthy athletes showed LGE, 62% of athletic HCM and 71% of sedentary HCM patients showed LGE in the hypertrophic segments or in the insertion points. Conclusions Based on our results CMR characteristics of sedentary and athletic HCM differs significantly, therefore establishing diagnostic parameters and cut-off values based on comparison between athletic HCM and healthy athletes would be essential. Presence of late gadolinium enhancement and derived parameters may have an important role in the differential diagnosis.